International Journal of

Nursing and Health Care Research

Montgomery AP and Patrician PA. Int J Nurs Health Care Res 03: 1204.

Research Article DOI: 10.29011/2688-9501.101204

The Concept of Burnout in the Nursing Profession

Aoyjai P. Montgomery*, Patricia A. Patrician
School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
Corresponding author: Aoyjai P. Montgomery, Postdoctoral Fellow, School of Nursing, University of Alabama at Birmingham,
*

NB573Q5 1720 2nd AVE S Birmingham, Alabama 35294-1210, USA

Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03:
1204. DOI: 10.29011/2688-9501.101204
Received Date: 06 November, 2020; Accepted Date: 25 November, 2020; Published Date: 30 November, 2020

Abstract
Introduction: Poor physical and mental health in nurses could decrease nurse performance and quality of care because nurses
are one of the most important factors in the healthcare system to improve quality of care. As the literature review indicates, burn-
out among nursing staff may play an important role in the occurrence of adverse patient events. However, a better understanding
of nurse burnout is still needed.
Aim: The aim is to clarify the meaning, attributes, antecedents, consequences, empirical indicators, and implications associated
with the concept of burnout in the nursing profession.
Design: The method of Walker and Avant was used.
Data Source: A review of nursing literature was conducted from 2005 to 2020. Articles were reviewed from CINAHL, PubMed,
and PsycINFO. Thirty-nine articles were included.
Results: The defining characteristics are emotional exhaustion, negative feelings and attitudes toward the recipients, and a feel-
ing of low accomplishment and professional failure. The factors that precede burnout are work environment factors as well as
personal characteristics. The consequences of nurse burnout are impacts on nurses, organizations, and patients. There are three
commonly used empirical indicators of burnout.
Conclusion: Burnout is an important topic for nurse educators and staff developers since it is an occupational hazard that new
nurses should anticipate. The sooner nurses recognize these signs and symptoms in themselves or other nurses, the better chance
they can minimize the effects on nurses, organizations, and patients.

Keywords: Burnout; Concept analysis; Nursing; Nurse members. Furthermore, keeping up with new health information
Burnout technologies, demanding too much of nurse’s time and attention
on a daily basis (Especially if the tools are not designed well),
Introduction can contribute to nurse burnout [4]. Thus, work-related stress, and
consequently burnout, is on the rise among nurses [3].
Nursing is a major key to improving the quality of patient care
by reducing adverse outcomes, particularly in hospitals setting [1]. Burnout has played a significant role for health care
Nurses experience many challenges including managing complex organizations because of its negative impact on workforce turnover,
medical care treatments and keeping up with more complicated job satisfaction, performance among nurses, and is a potential
diseases and current best practices [2]. The caregiving relationship detriment to patient safety [5-7]. The physical and mental health
between nurses and patients involves significant emotional output. of nurses could affect work performance, and this could lead to a
An ideal nurse is expected to be compassionate and empathic at lack of consistency in vigilance and overall quality of care [8,9].
all times, often creating internal turmoil [3]. Additional challenges Many studies report that increasing job demands have an impact
that nurses face include heavy workloads, time pressures, the on physical and psychological health, leading to such negative
needs of patients’ family members, and the demands of other staff effects as emotional exhaustion, psychosomatic complaints, and a

1 Volume 03; Issue 10

Int J Nurs Health Care Res, an open access journal

ISSN: 2688-9501
Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03: 1204. DOI: 10.29011/2688-9501.101204

lowered perception of job satisfaction as well as reduced quality of Materials and Methods
patient care [2,10-12].
The method of Walker and Avant [25], which is based on
Worldwide studies have reported high levels of burnout the original method of Wilson [26], was used as the framework
among nurses. The studies that explored burnout among nursing for this concept analysis. The Walker and Avant method has 8
staff in the United States (US) found that nurses reported high steps: “1) select a concept, 2) determine the aims or purpose of
levels of burnout [For example, high Emotional Exhaustion (EE), analysis, 3) identify all uses of the concept that can be discovered,
High Depersonalization (DP), low Personal Accomplishment 4) determine the defining attributes, 5) identify a model case,
(PA); these are three subscales of commonly used burnout 6) identify borderline, related, and contrary cases, 7) identify
measurements called Maslach Burnout Inventory (MBI)], and antecedents and consequences, and 8) define empirical referents”
these studies reported mean burnout scores that remained high [25]. Because the concept has been identified and the purpose of
for three consecutive years after graduation [13,14]. In China, analysis stated in the introduction section, steps 3 through 8 serve
nurses reported high levels of burnout concurrent with diminished as the framework for the rest of the results section. A review of
personal accomplishment [15]. Nearly 40% of nurses had a high nursing literature was conducted throughout the last decade to
level of EE, 25% of nurses reported high DP, and 49% reported the present. The databases that were used in this study included
low PA levels [15]. Approximately 30% to 60% of nurses reported CINAHL, PubMed, and PsycINFO.
high levels of burnout in eight of nine countries, including the
USA, China, South Korea, Thailand, Japan, New Zealand, the UK, Results
and Canada [16]. Likewise, a study of nurses in Thailand [17],
Computer searches using the keyword “burnout” resulted in
found 41% of nurses had high burnout scores.
3,107 articles from CINAHL, 9,679 articles from PsycINFO, and
Studies reported nurse burnout is associated with patient 8,640 articles from PubMed. The keyword “professional nursing
safety [18,19]; however, some studies claimed that only some burnout” narrowed the search. The number of articles found on
burnout dimensions are related to patient safety. For example, CINAHL, PsycINFO, and PubMed were 139; 524; and 1,024
Spence, et al. [7] found that two out of three categories of burnout— respectively, for a total of 1,687. Abstracts were reviewed to scan
EE and DP—were correlated with adverse events including falls, the articles and only articles that defined or described burnout in
nosocomial infections, medication errors, and patient complaints. the nursing profession (N=39) were used in this study.
Patient safety has become a core value within the contemporary
health care institutions and is based on data demonstrating better Identify All Uses of the Concept of Professional Nursing
patient outcomes with improved nursing care quality [20]. Ehsani, Burnout
et al. [21] determined that patients with adverse events extended Burnout first appeared in the literature to describe a
their hospital stays 10 days longer and were at seven times the phenomenon that was common to social service workers in the
risk of death that patients without complications. Dietsche [22] United States. The American psychologist Herbert Freudenberger
reported that the cost of patient safety events in the US and first coined the term “Burnout” in the 1970s. Although he first
European healthcare systems combined was $317.93 billion in used the term burnout to describe the effect of chronic drug abuse
2016. Frost and Sullivan [23] estimate the cost of patient safety in 1972 [27,28], he later described burnout as mental exhaustion
events in 2020 which will rise to $383.7 billion. Medication safety resulting from severe stress in the lives of human service workers
is one of the six biggest adverse events that contributes to these [29]. Merriam Webster’s definition of burnout is the status, both
costs [22]. physical and mental, of employees who encounter work-related
Joolaee, et al. [24] reported that medication errors were stress [27]. In addition, Maslach and Goldberg [30] defined burnout
adversely associated with nurse’ work conditions. As the as an individual stress experience that involves an individual and
literature review indicates, burnout among nursing staff may others in a prolonged response to chronic interpersonal stress
play an important role in the occurrence of adverse patient on the job. A relationship was established between burnout and
events. Therefore, reducing burnout among nurses could provide health and community services work [15,31,32]. The burnout
better nurse outcomes (Lower workforce turnover, better job phenomenon then drew attention in other English-speaking
satisfaction, and better nursing performance) and improve patient countries (e.g., Canada and England). Soon, a common research
outcomes especially patient safety in health care organizations. instrument, the Maslach Burnout Inventory, was translated into
To understand nurse burnout, the aim of this concept analysis French, German, Italian, Dutch, and Hebrew, for use in studies
is to clarify the meaning, attributes, antecedents, consequences, worldwide [28]. Therefore, the term burnout is most commonly
empirical indicators, and implications associated with the concept used to describe work-related mental stress experienced by workers
of burnout in the nursing profession. Also, exemplar cases of nurse in people-oriented occupations (e.g., human services, health care,
burnout are provided. and education).

2 Volume 03; Issue 10

Int J Nurs Health Care Res, an open access journal

ISSN: 2688-9501
Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03: 1204. DOI: 10.29011/2688-9501.101204

Burnout has been studied as outcomes of nurse characteristics

Maslach Burnout Inventory-Human
and work environments and also as a factor related to nurse, Services Survey (MBI)
patient, and healthcare organization outcomes, as discuss later in Empirical indicators Copenhagen Burnout Inventory (CBI)
this paper. Professional Quality of Life Scale
(ProQOL)
Determine the Defining Attributes
*Conflicting results
The defining characteristics of burnout that appear
consistently in the literature are emotional exhaustion or Table 1: Attributes, antecedents, consequences, and empirical
insufficient emotional energy to provide services, negative or indicators of burnout among nurses.
neutral feelings and attitudes toward the recipients of services, and
Identify a Model Case
a feeling of low accomplishment and professional failure [31-37]
(Table 1). It has been clearly reviewed that these three attributes Model Case
occur when an individual person experiences stress involves close
A model case, using a nursing example, was constructed
interpersonal relationships in the context of [38]. Therefore, these
to demonstrate all defining characteristics of burnout and to
three attributes (e.g. emotional exhaustion, negative or neutral
provide insight into the internal structure of the concept [25]. GD
feelings and attitudes toward the recipients of services, and a
is a 31-year-old female mental health nurse who has worked in
feeling of low accomplishment and professional failure) were
a community mental health center for 3 years. Her patients have
considered in terms of the nursing profession.
multiple needs with very few resources, and she has substantial
In sum, the definition of burnout that used in this concept responsibility for their care. She is also responsible for families
analysis is a state of physical and emotional exhaustion caused by in crisis (e.g., stressed family members and patients with mental
long-term exposure to situations that are emotionally demanding, illnesses). She often feels powerless to improve their health and
especially in people-oriented occupations such as nursing. Three well-being. One day, she said to one of her co-workers, “I feel
attributes include emotional exhaustion, negative or neutral so drained. I feel like I have changed from a caring individual to
feelings and attitudes toward the recipients of services, and a numb person in just two and a half years. I have a hard time falling
feeling of low accomplishment and professional failure used in asleep and then don’t want to get up and go to work. Some days,
these following cases. I am anxious, angry, and afraid without any reason. I feel like I
am hindrance to my co-workers. I need a long vacation to get
Emotional exhaustion away from my patients’ sicknesses and problems, and all my co-
Attributes Depersonalization workers; otherwise I might show my dark side. If my head nurse
Personal accomplishment won’t let me take vacation, I will quit this job because if I keep
Work environment or job setting working like this and feeling like this, I am afraid I may become
Work overload ineffective and not care at all anymore and quit my nursing job”.
Time pressure Discuss a Model Case: GD shows high emotional exhaustion
Ethical conflict
(saying “I feel so drained”), negative feelings and attitudes toward
Nurse-physician relations
Supervisors and peer support the recipients of services (Feeling “She often feels powerless
Antecedents Personal characteristics to improve their health and well-being”, and a feeling of low
Age accomplishment and thinking of quitting her job (Stating “I will
Gender quit this job because if I keep working like this and feeling like
Work experience this, I am afraid I may become ineffective and not care at all
Race anymore and quit my nursing job”.).
Marital status
Children in the home Identify Additional Cases
The identification of borderline, related, and contrary cases
Diminished organizational commitment
Affective commitment allowed the authors to distinguish between concepts similar and
Normative commitment contrary to burnout. However, it should be noted that all cases were
Consequences Cost commitment constructed because no factual cases were found in the literature.
Turnover and absenteeism
Borderline Case
Patient safety*
Physical and mental illness. MP is a new 24-year-old nurse who works in the Outpatient
Pediatric Department (OPD). Today 90 patients are in the

3 Volume 03; Issue 10

Int J Nurs Health Care Res, an open access journal

ISSN: 2688-9501
Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03: 1204. DOI: 10.29011/2688-9501.101204

department requiring nursing care. MP has already provided care work environment or job setting (Workload, time pressure,
to stressed family members and sick, crying children because of ethical conflicts, nurse-physician relations, and supervisors and
treatment delays due to the high volume of patients. With two peer support) and personal characteristics (Age, gender, work
hours left in her shift, she complains to her nurse manager, “Every experience, race, marital status, and children in the home) have
time I care for the sick kids and deal with upset parents, I try to been identified as factors associated with or leading up to burnout
prove to myself and others that I am a good nurse. Sometimes I (Table 1).
don’t feel like I give good care to the patients. I want to help them,
Work Environment or Job Setting: Nurses seem to report lower
but I don’t feel like doing it. Somedays, I am really emotionally
levels of burnout when they perceive better work environments
drained at work, but I feel better when I come home to be with my
[39-41]. Work overload is one of the factors that contributes to
lovely children and husband. They always make me smile and feel
professional nursing burnout [42]. Shoorideh, et al. [43] explored
better. Also, they make me realize that I must go on because of my
the relationship between work, individual factors, moral distress,
family responsibility because I really do love nursing so much.”
and burnout in intensive care nurses. The results showed that the
Discuss a Borderline Case: This case study includes two higher the patient-to-nurse ratio (i.e., the more patients per nurse),
characteristics of burnout, emotional exhaustion and negative the greater the workload for nurses. In addition, the higher the
feelings and attitudes toward the recipients of service. However, nurse-to-patient ratio, the more likely nurses are to experience
the nurse did not demonstrate feelings of low accomplishment or burnout. Among Emergency Department nurses, time pressures
professional failure. decrease their feelings of control and increased their experiences
of burnout compared to nurse practitioners, who reported the most
Related Case
control and the least burnout [13]. To explain the relationship
SD, a 50-year-old home health nurse, has cared for an between ethical conflicts and burnout among nurses, a correlation
overweight laparotomy patient for the pasts two days. She assists study was conducted in Poland [37]. Four of fourteen ethical
the patient with changing position every 2 hours and gives basic conflicts showed a significantly strong relationship to professional
nursing care. However, she feels she can’t accomplish nursing burnout, including being a witness to an unfair critique by a
tasks like she used to and feels like a failure as a nurse. Today, she colleague, being part of an inappropriate interpersonal relationship
calls her nurse manager to ask for a half shift off because she is between nurses, being a witness to the discrediting of a nurse by
experiencing back pain. another in the presence of a third party, and a lack of colleagues’
understanding when enhancing professional qualifications. Wang,
Discuss a Related Case: Although SD has feelings of low
et al. [44], conducting a nursing study in 6 hospitals in China,
accomplishment from taking care of the laparotomy patient, she
found that work-environment factors, including nurse-physician
demonstrates physical fatigue and feelings of tiredness, although
relationships and the ability of the nurse manager to be a leader and
she does not feel emotionally exhausted.
supporter, are related to all three dimensions of burnout. However,
Contrary Case Kalicińska, et al. [45] found that supervisor and peer support was
significantly related to only EE, not DP and PA.
CK has been working for 10 years in pediatric intensive care
at a university hospital. She loves caring for sick children, even Personal Characteristics: Personal characteristics which showed
though she often experiences both stressed family members and statistically significant differences in professional nursing burnout
a heavy workload. She keeps telling the new nurses, “I feel I am levels were age, gender, work experience, race, marital status, and
valued, that I’m doing something that actually helps other people. children in the home [46-49]. Padilla Fortunatti et al. [49] reported
When I see sick children feeling better and having happy lives that younger nurses had higher emotional exhaustion scores. These
with their families and their friends, it makes me so happy. I know results are congruent with other studies that predicted burnout by
this is my calling and where I am supposed to be”. nurse gender, age, and years of experience [36,43]. They reported
that male gender and younger age were significantly correlated
Discuss a Contrary Case: CK represents a clear example of a
with cynicism and a statistically significant relationship existed
nurse who is not experiencing burnout. She does not show signs
between work experience and depersonalization [36]. A study
of emotional exhaustion or depersonalization, or feelings of low
in a pediatric health care system reported that black participants
accomplishment. In other words, she is fully engaged in her work.
reported higher Personal Burnout, whereas white participants
Identify Antecedents and Consequences reported higher Work-related Burnout, and Asian nurses reported
higher Client-related Burnout [50]. Also, a lower level of personal
Antecedents
accomplishment was found in single individuals than in married
Walker and Avant [25] define antecedents as events that individuals. Likewise, nurses with children reported a greater
lead to the occurrence of the concept. Two antecedents, the sense of personal accomplishment than those who had no children

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Int J Nurs Health Care Res, an open access journal

ISSN: 2688-9501
Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03: 1204. DOI: 10.29011/2688-9501.101204

[46,47,48,51]. However, single parents reported higher burnout It appears that the prevention of burnout has not been studied
levels (High EE, high DP, low PA, and high overall burnout) sufficiently as an antecedent of patient safety.
than those who lived with partners [52]. In sum, the factors that
Nurse Outcomes: Nurses who had high levels of burnout, such
precede burnout among nurses are work environment factors (i.e.,
as new graduate nurses and emergency nurses, reported more
work overload, time pressure, and ethical conflicts) and personal
stressors, depressive symptoms, and hostility towards them
characteristics (i.e., age, gender, work experience, race, marital
[13,14]. Lower level of satisfaction was another consequence of
status, and children in the home).
high burnout levels that was found in this literature review [61-
Consequences 64]. Lower job satisfaction has been shown consistently to predict
turnover; indeed Zhang et al. [15] found nurse burnout preceded
Walker and Avant [25] describe consequences as events
turnover and absenteeism. Jourdain and Chênevert [65] conducted
that happen as a result of the concept. The consequences of nurse
a survey to explore the relationship between job demands, burnout
burnout can be grouped into three major categories; organizational
and intention to leave among nurses in the Canadian public
outcomes, patient outcomes, and nurse outcomes.
healthcare sector. They found that emotional exhaustion and
Organization Outcomes: In Zhang, et al. [15], Zhou, et al. [53] and depersonalization were significantly correlated with the intention
Cao, et al. [54], studies of nurses in China, a negative correlation was to leave the profession.
found between the three dimensions of professional burnout (i.e.,
Finally, another consequence of burnout, depressive
emotional exhaustion, depersonalization, and reduced personal
symptoms were found in a study of the first three years of nurse
accomplishment) and the three dimensions of organizational
practitioner practice [14]. In addition, newly-registered nurses
commitment ( i.e., affective commitment, normative commitment,
who experienced burnout exhibited the following symptoms:
and cost commitment). Furthermore, Fragoso et al. [55] found that
low self-esteem, irritability, depression, emotional exhaustion
total scores on burnout using the Copenhagen Burnout Inventory
and disengagement. The participants also reported impaired sleep
was negatively related to organization commitment using the
quality and poor eating habits [14]. Therefore, consequences of
affective Commitment Scale. These results are congruent with
nurse burnout include diminished organizational commitment,
a study that examined the correlation between burnout and
turnover, absenteeism, and physical and mental illness.
productivity among Iranian nurses [35]. The findings of Nayeri
et al. [35] suggested that productivity had a significant negative Define Empirical Referents
correlation to emotional exhaustion and depersonalization. A
According to Walker and Avant [25], empirical referents
significant positive correlation was found between productivity
demonstrate the occurrence of the concept. Empirical indicators
and personal accomplishment.
of burnout provide nurses and others with observable phenomena
Patient Outcomes: Burnout was a mediating variable in the by which to measure the level of burnout in an individual level
relationship between emotional intelligence and caring behavior (Table 1). There are three most commonly used burnout empirical
[56]. Strong evidence connects better nurse outcomes to better indicators among nurses including the MBI, the Copenhagen
patient outcomes. Many studies reported that high burnout levels Burnout Inventory (CBI), and the Professional Quality of Life
among nurses were significantly related to poor or fair quality Scale (ProQOL).
of nursing care [17,35,57,58]. Adverse patient events may be
MBI
a consequence of burnout, but this relationship has conflicting
results in the literature. Studies conducted in Canada and Belgium The Maslach Burnout Inventory-Human Services Survey
reported that burnout among nursing staff was associated with [30] has been the most commonly used empirical indicator of
patient adverse patient events (Patient falls, nosocomial infections, burnout [31,32,35-37]. The key aspects of this instrument are
patient and family complaints, and medication errors) [34,59]. increasing feeling of emotional exhaustion; developing negative
These findings conflict with a study conducted to investigate attitude toward to clients; and evaluating themselves negatively
the relationship between nurse burnout among 148 nurses from and feeling dissatisfied with their accomplishments on the
a Midwestern Veteran’s Administration (VA) hospital and patient job [66]. These key aspects consistent with three attributes of
safety [60]. These researchers found no significant relationship burnout (Emotional exhaustion, negative or neutral feelings and
between nurse burnout and adverse event reports. Two explanations attitudes toward the recipients of services, and a feeling of low
of this unexpected result were as follows: 1) reports of adverse accomplishment and professional failure). These indicate clearly
events were extremely rare, and 2) participants may have felt that why the MBI Human Services Survey is the most common
that adverse event reports required too much effort. The lack instrument for measuring burnout in nurses. This survey includes
of consistent findings regarding the relationship between nurse 22 items divided into three components; 1) Emotional Exhaustion
burnout and patient safety is a consequent gap in the literature. (EE); 2) Depersonalization (DP); and 3) Personal Accomplishment

5 Volume 03; Issue 10

Int J Nurs Health Care Res, an open access journal

ISSN: 2688-9501
Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03: 1204. DOI: 10.29011/2688-9501.101204

[30]. The MBI uses the scores from all three components to identify
- Feelings of apathy or hopelessness
burnout (i.e., EE >27; DP >10; and PA < 33).
Low personal - Feeling ineffective or useless
CBI
accomplishment and
- Poor performance
Other empirical indicators of nurse burnout that have been professional failure
used in the 15 years are the Copenhagen Burnout Inventory (CBI). - Decreased satisfaction and sense of
accomplishment
Allen, et al. [67] used CBI to examine the relationship between
bullying and burnout, and Shoorideh et al. [43] used this tool Source [14,71].
to determine the relationship between burnout and turnover in
Table 2: Attributes and associated signs and symptoms of burnout.
intensive care unit nurses. The CBI has three dimensions (i.e.,
Personal, Client-related, and Work-related Burnout). Participants Discussion
with high burnout levels scored greater than 50 overall on the three
categories [68]. Burnout is an important topic for nurse educators and staff
developers since it is an occupational hazard that new nurses
ProQOL should anticipate. To ensure safe patient care and better patient
The Professional Quality of Life Scale (ProQOL) was safety outcomes, burnout needs to be reduced. The sooner nurses
used in a nonexperimental, descriptive, predictive study by recognize the burnout signs and symptoms in themselves or other
Hunsaker, et al. [69] to examine the prevalence of compassion nurses, the better chance they can avoid or minimize the effects
satisfaction, compassion fatigue, and burnout among U.S. of burnout including effects on nurses themselves, healthcare
emergency nurses. According to the ProQOL developers, there organizations, and quality of patient care and safe. New nurses
are two scales: compassion satisfaction and compassion fatigue. should know the signs of burnout and ask for help when they
Burnout is a subscale of the compassion fatigue along with need it. The attributes of burnout indicate clearly that the MBI
Secondary Traumatic Stress (STS) [70]. However, without these Human Services Survey is the most common instrument for
three empirical indicators on hand, nurses, co-workers, or nurse measuring burnout in nursing; however, the CBI is also applicable
managers can recognize the signs and symptoms of each attribute and does not have a cost associated with its use. Furthermore,
by following (Table 2). For example, emotional exhaustion could the antecedents or factors that could lead higher burnout were
show as lack of energy, feeling drained, changes in eating habits, summarized into two categories including the work environment
appetite, or change in sleep patterns. or job setting (workload, time pressure, ethical conflicts, nurse-
physician relations, and supervisors and peer support); and personal
Attributes Signs and Symptoms characteristics (age, gender, work experience, race, marital status,
and children in the home). The reasons that these factors could lead
- Lack of energy Feeling drained
to higher nurse burnout are explained as follows. Organizational
- A sense of dread and management characteristics influencing nurse burnout have
included the lack of supportive clinical supervision, lack of
- Impaired concentration or less attention
adequate resources to accomplish the work, excessive workloads,
- Changes in eating habits or appetite staff shortages, and a low nurse to patient ratio [72,73]. A lack
Emotional exhaustion of hospital management and organizational support for nursing
- Changes in sleep
is associated with both dissatisfaction in the nursing profession
- Irritability - Depression and nurse burnout [74]. According to Aiken et al. [61], significant
- Angry outbursts
changes or improvements in all aspects of the nurse practice work
environment might not be realistic; however, small changes in the
- Headaches or muscle aches quality of work environment would reduce nurse burnout.
- Loss of enjoyment at work/ not wanting
Certain personal characteristics are associated with burnout.
to go to work
Regarding age, Erickson and Grove [75] found that nurses below
- Pessimism or cynicism
Negative or neutral the age of 30 experienced higher burnout than those over age
feelings and attitudes - Isolation 30, and also that nurses under 30 were less likely to hide their
toward recipients true emotions than those over 30. Based on work experience, it
- Feelings of detachment
(patients) could be explained by the fact that nurses with more experience
- Disengagement may have more confidence about their jobs and more meaningful,
developed relationships with co-workers, both in the nursing
- Withdrawing from responsibilities
profession and with other professions at work. Nurses with

6 Volume 03; Issue 10

Int J Nurs Health Care Res, an open access journal

ISSN: 2688-9501
Citation: Montgomery AP, Patrician PA (2020) The Concept of Burnout in the Nursing Profession. Int J Nurs Health Care Res 03: 1204. DOI: 10.29011/2688-9501.101204

more experience in their current hospital are more likely to nurses may be more prone to burnout. Thus, these nurses should
have previously experienced most scenarios. As a result, they be a primary target population for burnout prevention programs,
are more likely to understand and manage problems or potential and for hospital initiatives to promote clinician well-being at work.
ambiguous situations at work with more confidence and certainty Nurse Managers should also be aware of the physical, mental,
[76]. In term of gender, males compromise a lower proportion of and emotional effort required of a nursing professional, and, if
nurses than females, and when males choose female dominant necessary, provide support from among nurses’ peers, supervisors,
occupation, they tend to experience role conflict and high burnout and other professionals or to request interventions for burnout
[36,77-79]. Based on races, Kern and Grandey [80] hypothesized treatment or prevention.
that customer incivility or microaggressions against racially
Education Setting
diverse employees may contribute to higher burnout in a retail
environment. This hypothesis could support the findings that other Nursing school curriculum at the undergraduate and graduate
races reported higher burnout in the dominant racial area (e.g. program levels should include content related to nurse burnout and
white in the United States). The findings based on marital status its prevention. To prevent burnout among nurses, nursing students
and children in the home could be explained by the fact that the should have the knowledge and skills to recognize signs and
family environment provides security and support, which protects symptoms of burnout (Table 2) and evaluate themselves or their
nurses from developing impersonal, cynical, and negative attitudes co-workers, and either the MBI or the CBI instrument could be
towards patients and/or colleagues in the workplace [81]. used to classify burnout levels.
One of the limitations of this concept analysis is the time frame Conclusion
for the literature search. We would like to capture nurse burnout
in the most current work environment and nurse characteristics Burnout among nurses is an individual response to chronic
but also would like to capture the most information. Therefore, occupational stress caused by both interpersonal and organizational
the literature review spans only the last 15 years, the antecedents, stressors. This stress experience includes three attributes,
consequences, and empirical indicators that had been mentioned emotional exhaustion, depersonalization, and feels of low personal
in the literature before 2005 are excluded. Also, the indicators of accomplishment on the job. This concept analysis of burnout
burnout have been generated from disciplines outside of nursing uncovered a unique set of attributes, antecedents, consequences
but have been applied to the nursing profession. The empirical and empirical referents of burnout (Table 1) that can be applied to
indicators may not cover all antecedents of burnout within the nursing research, nursing practice, and nursing education. There
nursing profession (e.g., time pressure), and there may be even are three commonly used burnout empirical indicators, and the
more that we are unaware of situations, such as bullying. These most commonly used is MBI. All three components of burnout
important antecedents of nursing burnout may require qualitative (i.e., EE, DP, and low PA) are characterized by signs and symptoms
study beyond the MBI. that might overlap in some components (Table 2).

Implications Acknowledgments
Research Setting The views expressed in this article are those of the authors
One result of this concept analysis is the gap in the literature and do not necessarily reflect the views of University of Alabama
concerning adverse patient events as a consequence of nurse at Birmingham.
burnout. Also, the few studies that do exist on burnout and patient Funding Information
safety report conflicting results. Further research is required to
determine the effects of nurse burnout on patient safety. The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Clinical Setting
Conflict of Interests
Furthermore, the findings of this literature review indicate
that burnout plays a significant role in organizational commitment The authors declare that there are no conflicts of interest that
and nurse health. Therefore, the organization and nursing could be perceived as prejudicing the impartiality of the research
administration should develop strategies to create a supportive reported.
work environment for nurses to reduce nurse burnout and resulting
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